North American Spine Society Journal最新文献

{"title":"Lateral lumbar interbody fusion versus single position prone transpsoas approach: A comprehensive bibliometric analysis","authors":"Meriem Boukhiam MD ,&nbsp;Abdulwhab Alotaibi MD ,&nbsp;Omid Yousefi MD ,&nbsp;Gilberto Perez Rodriguez Garcia MD ,&nbsp;Ataollah Shahbandi MD ,&nbsp;Saman Shabani MD ,&nbsp;Muhammad M. Abd-El-Barr MD, PhD ,&nbsp;Mohamad Bakhaidar MD","doi":"10.1016/j.xnsj.2025.100837","DOIUrl":"10.1016/j.xnsj.2025.100837","url":null,"abstract":"<div><h3>Background</h3><div>Lateral lumbar interbody fusion (LLIF) and single position prone lateral (PTP) approaches represent significant advances in minimally invasive spine surgery, yet comprehensive comparative analysis of their research trajectories remains limited.</div></div><div><h3>Purpose</h3><div>This bibliometric analysis aims to comprehensively compare the scientific landscapes surrounding LLIF and PTP approaches by examining publication trends, citation patterns, authorship networks, and thematic evolution.</div></div><div><h3>Methods</h3><div>We systematically searched Scopus, PubMed and Google Scholar from inception through September 2025 for articles addressing LLIF and single position prone lateral approaches. Bibliometrix package in R was used to complete the bibliometric analysis. We included the following parameters: publication output, citation metrics, journal distribution, author productivity, international collaboration networks, keyword co-occurrence, and thematic mapping in the analysis.</div></div><div><h3>Results</h3><div>We identified 823 LLIF publications and 107 single position prone lateral publications. LLIF accounted for 20,707 total citations with an h-index of 70 and a mean of 31.93 citations per document, whereas PTP accumulated 915 citations with an h-index of 17 and a mean of 8.44 citations per document. Although LLIF has a larger volume of publications, PTP has progressed more rapidly, showing annual growth rates of 44% compared with 30% for LLIF during comparable developmental periods. The United States contributed 45.6% of LLIF and 71.8% of PTP publications, with LLIF research spanning 42 countries and PTP 16 countries. Core research themes for both techniques evolved from technical descriptions to comparative effectiveness studies, and the substantial overlap in authors and institutions indicates complementary rather than competitive research trajectories.</div></div><div><h3>Conclusions</h3><div>LLIF represents a mature surgical approach with a strong evidence base while PTP demonstrates accelerating research interest, with growth trajectories exceeding those of LLIF during comparable developmental stages. Based on current publication trends and thematic evolution, future research on PTP should prioritize rigorous comparative studies, long-term outcome evaluations, cost-effectiveness analyses, and patient-centered outcome research to strengthen the evidence base and guide clinical adoption.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100837"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A room with a view: Recovery bed environment following pediatric spinal fusion","authors":"Alexa P. Bosco BA ,&nbsp;Margaret L. Sullivan BS ,&nbsp;Daniel Gabriel BA, MBA ,&nbsp;Shanika De Silva PhD ,&nbsp;Daniel Hedequist MD ,&nbsp;Michael T. Hresko MD ,&nbsp;Craig Munro Birch MD ,&nbsp;Grant D. Hogue MD","doi":"10.1016/j.xnsj.2026.100848","DOIUrl":"10.1016/j.xnsj.2026.100848","url":null,"abstract":"<div><h3>Background Context</h3><div>Patients in a double-occupancy room during recovery will have different experiences based on bed location. For instance, patients near a window will have access to natural light while a patient near the door may experience higher noise levels. This study aims to assess the impact of inpatient bed placement on postoperative recovery for adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF).</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 448 AIS patients who underwent PSF from 2011 to 2017 at a single center. Demographics and baseline radiographic measurements were summarized using appropriate statistics. Intraoperative and postoperative outcomes, NRS pain scores and total daily opioid administration were compared across bed types using t-tests, Wilcoxon rank sum tests, chi-squared tests, or Fisher’s exact tests, as appropriate. GEE models were constructed to examine the influence of bed type and days since surgery on outcomes such as postoperative complication, PACU pain levels, length of stay, daily numerical ranking scale (NRS) pain scores and total daily opioid administration.</div></div><div><h3>Results</h3><div>325 (73%) patients in the cohort were assigned to a bed by the window and 123 (27%) were assigned to a bed by the door. The mean age was 15±2 years and 85% of patients were female. Length of hospital stay, complication rates, 2-year outcomes, inpatient pain scores, and daily opioid usage did not significantly differ between bed types (all p&gt;.05). Adjusted GEE models revealed no significant associations between bed type and pain scores (p=.9) or between bed type and total opioid dosage (p=.95).</div></div><div><h3>Conclusions</h3><div>Proximity to a window while recovering from PSF surgery for AIS does not impact inpatient outcomes. When bed space is scarce, usage of all available beds can serve as a relief valve to continue elective practices without compromising postoperative outcomes.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100848"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel 360° lumbar arthroplasty: Surgical technique and procedural details","authors":"Jared D. Ament MD, MPH, FAANS, FACS ,&nbsp;Jack Petros BS ,&nbsp;Cooper Gardner BS ,&nbsp;Amir Vokshoor MD, FAANS","doi":"10.1016/j.xnsj.2026.100863","DOIUrl":"10.1016/j.xnsj.2026.100863","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the operative technique, dedicated intraoperative calibration workflow, and perioperative management protocol for 360° lumbar arthroplasty, a dual-approach, motion-preserving alternative to fusion addressing concurrent disc and facet pathology at a single lumbar level.</div></div><div><h3>Background</h3><div>Conventional fusion restricts segmental motion, potentially increasing stress on adjacent levels. The combination of the Prodisc L, artificial disc replacement, and the Total Posterior System from enables circumferential reconstruction of the lumbar motion segment while preserving physiologic kinematics. A novel intraoperative calibration device allows precise alignment of the Total Posterior System to the artificial disc replacement, optimizing segmental center of rotation and motion preservation.</div></div><div><h3>Methods</h3><div>Patient selection, preoperative imaging, sequential anterior-posterior surgical technique, dedicated intraoperative center of rotation calibration protocol, device sizing, and postoperative rehabilitation protocols are detailed. Biomechanical validation of the calibration device is incorporated to support its clinical application.</div></div><div><h3>Results</h3><div>Early results of 24 patients over 2 years are encouraging. Total VAS and ODI scores decreased by 9 (89%) and 50 (88%) points, respectively. The SF36 PCS/MCS scores increased by 63/49 (114%/100%). A total of 9 patients were discharged the same day, while 14 were sent to a post-op rehab center for 1 to 3 days. Average return to light physical activity (swimming, golfing, fencing, hiking, gym) was 4 weeks (SD2.2).</div></div><div><h3>Conclusions</h3><div>This 360° motion-preserving construct integrates validated anterior and posterior arthroplasty systems with a novel intraoperative calibration to restore both disc and facet function, representing an evolution in lumbar spine surgery.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100863"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147396083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tarlov cysts and sexual dysfunction: A multidisciplinary approach to evaluation and surgical treatment","authors":"Shashank Coorapati BS ,&nbsp;Irwin Goldstein MD ,&nbsp;Sue W. Goldstein BA, CSE, CCRC ,&nbsp;Barry R. Komisaruk PhD ,&nbsp;Choll W. Kim MD, PhD","doi":"10.1016/j.xnsj.2026.100866","DOIUrl":"10.1016/j.xnsj.2026.100866","url":null,"abstract":"<div><h3>Background</h3><div>Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD) involves chronic, unrelenting arousal and dysesthesia of the genito-pelvic region. In 2012, Komisaruk and Lee identified a high incidence of sacral Tarlov cysts in patients with PGAD/GPD, prompting development of a multidisciplinary diagnostic and treatment algorithm. This study reviews surgical outcomes for patients with PGAD/GPD in whom a Tarlov cyst was identified as the symptomatic driver.</div></div><div><h3>Methods</h3><div>A retrospective review of prospectively collected data was conducted on patients with PGAD/GPD who underwent Tarlov cyst excision and imbrication from 2017 to 2023. The diagnostic algorithm included neurogenital testing, sacral MRI, and assessment for pelvic or end-organ triggers.</div><div>When one or more cysts were suspected as the etiology, a targeted diagnostic injection with anesthetic and steroid confirmed the diagnosis.</div><div>Operative reports, imaging, and pre/postoperative clinic visits were reviewed to assess complications, readmissions, reoperations, and symptom changes. Outcomes were measured using the Patient Global Impression of Improvement (PGI-I), Oswestry Disability Index (ODI), Sexual Distress Scale-Revised (SDS-R), and Visual Analog Scale (VAS) for back pain.</div></div><div><h3>Results</h3><div>Nineteen patients (mean age 45.5 ± 15.9 years) with an average follow-up of 18.2 ± 10.5 months were included. Fourteen patients (73.7%) reported postoperative improvement on the PGI-I: 2 “very much better,” 9 “much better,” 3 “little better,” and 5 with no improvement. No patients reported worsening symptoms. All were discharged the same day, with no cerebrospinal fluid leaks, wound issues, or cyst recurrences. Oswestry Disability Index improved from 32.9 to 28.4, SDS-R from 30.9 to 26.8, and Visual Analog Scale back pain from 4.8 to 3.2.</div></div><div><h3>Conclusions</h3><div>Symptomatic Tarlov cysts can contribute to PGAD/GPD and associated sexual dysfunction. Early detection with a structured diagnostic algorithm support accurate patient selection and safe, effective surgical treatment, offering meaningful symptom relief for appropriately selected patients.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100866"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147448754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shaping the future of blood management in metastatic spine tumor surgery: the case for cell-salvaged transfusion with a propensity-matched study","authors":"Si Jian Hui MBBS, MRCS ,&nbsp;Jiong Hao Tan MBBS, MRCS, MMed, FRCS ,&nbsp;Shen Liang PhD ,&nbsp;Yong Hao Tan MBBS, MRCS, MMed ,&nbsp;Balamurugan Vellayappan MBBS, GDFM, FRANZCR ,&nbsp;Namith Rangaswamy MBBS, MS, DNB, MRCS, MNAMS ,&nbsp;Laranya Kumar MBBS ,&nbsp;Youheng Ou Yang MBBS, MRCS, MCEM, MMed, FRCS ,&nbsp;James Thomas Patrick Decourcy Hallinan MBChB, BSc, FRCR ,&nbsp;Naresh Kumar MBBS, MS, DNB, FRCS, DM","doi":"10.1016/j.xnsj.2026.100862","DOIUrl":"10.1016/j.xnsj.2026.100862","url":null,"abstract":"<div><h3>Background</h3><div>Blood loss is a major perioperative concern in metastatic spine tumor surgery (MSTS). Allogeneic blood transfusion (ABT) remains the standard method of blood replacement but is associated with well-recognised complications. Salvaged blood transfusion (SBT) using intraoperative cell salvage may mitigate many of these risks; however, its oncological safety and long-term outcomes in MSTS remain controversial.</div></div><div><h3>Methods</h3><div>This was a prospective cohort study of patients who underwent MSTS between 2014 and 2017. Clinical outcomes included overall survival (OS) and tumor progression (TP), assessed using RECIST (version 1.1). A propensity score–matched cohort was generated using relevant predictors of treatment allocation and outcomes of interest to enable comparison between patients receiving SBT and ABT.</div></div><div><h3>Results</h3><div>A total of 98 patients (mean age 60 years) were included, of whom 33 received SBT, 39 received ABT, and 26 received no blood transfusion. Median estimated blood loss was 400 mL (IQR 200–900 mL), and median blood transfusion volume was 328.5 mL (IQR 0–1042 mL). Propensity score matching yielded 30 patients in the ABT group and 28 in the SBT group. There was no significant difference in overall survival between patients receiving SBT and ABT (p=.250). Importantly, SBT was not associated with an increased risk of 4-year TP (p=.908).</div></div><div><h3>Conclusions</h3><div>SBT demonstrates comparable long-term survival and TP outcomes to ABT in patients undergoing MSTS, while avoiding the known complications associated with ABT. This study represents the first long-term propensity score–matched analysis of SBT in MSTS, supporting its oncological safety and clinical utility in contemporary spine oncology practice.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100862"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147448757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric versus adult cases of primary osseous sarcomas of the spine: A population-based analysis","authors":"Christopher J. Carron BS,&nbsp;Ali Ebada BS,&nbsp;Nicholas Bever BS,&nbsp;Mary Ashley Liu MD,&nbsp;Salah G. Aoun MD","doi":"10.1016/j.xnsj.2026.100865","DOIUrl":"10.1016/j.xnsj.2026.100865","url":null,"abstract":"<div><h3>Background</h3><div>Primary osseous sarcomas of the spine provide a challenge due to their anatomic location and aggressiveness. While chemotherapy, radiation, and surgery are frequently employed as treatments for these neoplasms, their efficacy has not been compared between children and adults.</div></div><div><h3>Methods</h3><div>Using the Surveillance, Epidemiology, and End Results database (2000–2021), 455 patients were identified with confirmed osteosarcoma, Ewing’s sarcoma, or chondrosarcoma. Demographic, tumor, and treatment characteristics were analyzed. Cox proportional hazard models were used to evaluate mortality predictors, and Kaplan–Meier survival analysis was performed.</div></div><div><h3>Results</h3><div>For the entire cohort, increasing age (hazard ratio [HR]=1.03; 95% confidence interval [CI]=1.01–1.04; p&lt;.001), an osteosarcoma diagnosis (HR=2.06; CI=1.17–3.61; p=.0019), and increasing tumor size (HR=1.01, CI=1–1.02, p=.007) increased mortality risk. For adults, age, an osteosarcoma diagnosis, male sex (HR=1.94; CI=1.07–3.52; p=.0297) and Black race (HR=3.16; CI=1.07–9.34; p=.0374) conferred a poor prognosis. Subtotal tumor resection was protective for adults (HR=0.29; CI=0.09–0.92; p=.0355). For children, only increasing age (HR=1.13; CI=1.03–1.23; p=.00678) decreased survival. Kaplan–Meier analysis revealed cohort-wide median cancer-specific survival (CSS) of 82 months, with 5- and 10-year survival rates of 53% and 47%. Adult median CSS was 34 months, with 5- and 10-year survival rates of 44% and 37%. Median CSS was not reached in the pediatric cohort, with 5- and 10-year CSS rates of 69% and 64%.</div></div><div><h3>Conclusions</h3><div>Children experienced improved CSS compared to adults. While resections were associated with survival in adults, survival in pediatric patients was not significantly influenced by treatment-related variables. These findings suggest that patient age and histology should guide prognosis and treatment strategy.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100865"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147396003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjacent segment degeneration after superior facet joint violation of the lumbar spine","authors":"Conor McNamee MB, BCh, BAO, MCh ,&nbsp;Bryan Magee BSc ,&nbsp;Richard N. Storey MBChB, FRACS ,&nbsp;Jake M. McDonnell MRCS ,&nbsp;Stacey Darwish MBChB, FRCS ,&nbsp;Joseph S. Butler PhD, FRCS","doi":"10.1016/j.xnsj.2025.100843","DOIUrl":"10.1016/j.xnsj.2025.100843","url":null,"abstract":"<div><h3>Background</h3><div>Facet joint violation (FJV) is a recognized complication of pedicle screw fixation and has been proposed as a driver of adjacent segment disease (ASD). Biomechanical models suggest that FJV may alter segmental kinematics, but its clinical impact on degeneration and reoperation remains uncertain. This work evaluates whether superior FJV is associated with an increased risk of radiographic ASD or reoperation after lumbar fusion.</div></div><div><h3>Methods</h3><div>Retrospective cohort study of patients undergoing lumbar pedicle screw fixation with postoperative CT imaging that captured the instrumentation and the cranial adjacent segment. Superior FJV was graded using an established 3-tier system. Follow-up imaging was assessed for disc height loss, progression of spondylolisthesis, coronal deformity, central stenosis, lateral recess height and a composite degeneration endpoint; reoperations were recorded. Propensity score weighting balanced measured covariates, and a weighted cox regression was used for time-to-event analyses.</div></div><div><h3>Results</h3><div>Seventy-one patients met inclusion criteria, with FJV identified in 35 (49.3%). Weighted analyses demonstrated no significant association between FJV and disc height loss (HR 1.21, 95% CI 0.54–2.72), progression of spondylolisthesis (HR 0.59, 95% CI 0.13–2.65), coronal deformity (HR 2.18, 95% CI 0.48–10.01), central stenosis (HR 1.35, 95% CI 0.21–8.61), composite degeneration (HR 1.76, 95% CI 0.87–3.56), or reoperation (HR 0.44, 95% CI 0.12–1.62). Exploratory subgroup analysis suggested that minor (grade 1) violations may contribute to axial instability, whereas full joint traversal (grade 2) may confer relative stability, though neither reached statistical significance.</div></div><div><h3>Conclusions</h3><div>In this cohort with extended follow-up, superior FJV was not significantly associated with any measure of radiographic degeneration or reoperation. These findings suggest that FJV may not be a major determinant of long-term outcomes after lumbar fusion. Further biomechanical and clinical studies are warranted to clarify whether specific grades of FJV differentially affect cranial segment stability and screw performance.</div></div><div><h3>140 characters</h3><div>Superior FJV on CT didn’t significantly increase hazards of disc height loss, listhesis, stenosis, deformity, or reop after fusion.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100843"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cefazolin prophylaxis is associated with lower surgical site infection risk than vancomycin following elective spine surgery","authors":"Michael S. Kim MD,&nbsp;Melissa R. Romoff BA,&nbsp;Ryan Beyer MD,&nbsp;Emily Tse BA,&nbsp;Hao-Hua Wu MD,&nbsp;Don Y. Park MD,&nbsp;Yu-Po Lee MD,&nbsp;Nitin Bhatia MD,&nbsp;Sohaib Hashmi MD,&nbsp;Emily S. Mills","doi":"10.1016/j.xnsj.2026.100857","DOIUrl":"10.1016/j.xnsj.2026.100857","url":null,"abstract":"<div><h3>Background</h3><div>Surgical site infection (SSI) remains a major cause of morbidity following elective spine surgery, with incidence rates up to 3%. Current guidelines recommend cefazolin as the first-line prophylactic antibiotic due to its efficacy against methicillin-sensitive <em>Staphylococcus aureus</em> (MSSA) and coagulase-negative staphylococci (CoNS). However, reported B-lactam allergies are commonly cited in clinical practice as a reason for substitution with vancomycin, which provides inferior coverage for MSSA and limited gram-negative activity. Prior single center studies suggest higher SSI risk with vancomycin, but large-scale evidence remains limited.</div></div><div><h3>Methods</h3><div>A retrospective cohort analysis was conducted using the TriNetX US Collaborative Network (2015-2023). Adults undergoing elective spine surgery, including transforaminal or posterior interbody fusion (TLIF/PLIF), multilevel lumbar fusion, posterior cervical fusion, anterior cervical discectomy and fusions (ACDF), and microdiscectomy, were identified. Patients receiving perioperative cefazolin or vancomycin within 24 hours of surgery were included. 1:1 propensity score matching controlled for demographics, comorbidities, and infection risk factors. The primary outcome was 90-day SSI, assessed using ICD-10 diagnosis codes. Risk ratios (RR) were estimated using Cox proportional hazards models.</div></div><div><h3>Results</h3><div>After matching, 12,996 patients were included across 5 procedure cohorts. Cefazolin prophylaxis was associated with lower or comparable SSI risk compared with vancomycin across all procedures. Statistically significant differences were observed for TLIF/PLIF (0.82% vs. 2.30%; RR 0.36, 95% CI 0.18–0.7; p = .0019) and microdiscectomy (0.34% vs. 0.69%; RR 0.50, 95% CI 0.27–0.93; p = .025). Nonsignificant trends favored cefazolin for posterior cervical fusion (0.88% vs. 1.41%), multilevel lumbar fusion (1.25% vs. 1.51%), and ACDF (0.30% vs. 0.54%).</div></div><div><h3>Conclusions</h3><div>Cefazolin prophylaxis is associated with significantly lower SSI risk in elective spine procedures. These findings support cefazolin as the preferred perioperative antibiotic and emphasize the need for accurate B-lactam allergy assessment to optimize infection prevention and antimicrobial stewardship in spine surgery.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100857"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147448755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proton pump inhibitors are associated with increased risk of pseudoarthrosis after lumbar fusion","authors":"Melissa Romoff BA,&nbsp;Michael S. Kim MD,&nbsp;Courtney Spitzer BA,&nbsp;Andy Ton MD,&nbsp;Vivian Chen MD,&nbsp;Ryan Le MD,&nbsp;Abhinav Sharma MD,&nbsp;Emily Mills MD,&nbsp;Hao-Hua Wu MD,&nbsp;Don Young Park MD,&nbsp;Yu-Po Lee MD,&nbsp;Nitin Bhatia MD,&nbsp;Sohaib Hashmi MD","doi":"10.1016/j.xnsj.2025.100829","DOIUrl":"10.1016/j.xnsj.2025.100829","url":null,"abstract":"<div><h3>Background</h3><div>Pseudoarthrosis is a major complication following lumbar spine fusion, leading to revision surgery, increased disability, and substantial economic burden. Proton pump inhibitors (PPIs) are commonly used in the perioperative period, but their impact on fusion success remains poorly defined.</div></div><div><h3>Methods</h3><div>This retrospective cohort study utilized the TriNetX research database to identify adult patients undergoing lumbar spine fusion. Patients were divided into 2 cohorts based on documented PPI use within 30 days postoperatively and underwent 1:1 propensity score matching based on demographic and clinical characteristics. The incidence of pseudoarthrosis was assessed using diagnostic coding, and risk was compared using risk ratios and Kaplan-Meier survival analysis. An age-stratified analysis was also performed.</div></div><div><h3>Results</h3><div>A total of 122,584 matched pairs were analyzed. Pseudoarthrosis occurred in 7.38% of PPI users compared to 3.98% of nonusers (RR: 1.88; p &lt; .0001). Kaplan-Meier survival analysis revealed early separation of pseudoarthrosis-free survival curves by postoperative day 60, persisting through 1-year follow-up. Age-stratified analysis showed consistently higher pseudoarthrosis risk among PPI users across all age groups, with the largest relative impact observed in patients under 55 years old.</div></div><div><h3>Conclusions</h3><div>Postoperative PPI use is associated with a significantly increased risk of pseudoarthrosis following lumbar spine fusion. These findings suggest careful consideration of the necessity of PPI therapy in the perioperative period, particularly in younger patients where the relative impact appears the greatest.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100829"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145840985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative complications and mechanical outcomes following endoscopic versus open lumbar fusion: A propensity-matched analysis","authors":"Ryan Wang BS ,&nbsp;William Zeng BS ,&nbsp;Alexander T. Hong BS ,&nbsp;Hannah Cho BS ,&nbsp;Syed I. Khalid MD ,&nbsp;Ankit I. Mehta MD","doi":"10.1016/j.xnsj.2026.100855","DOIUrl":"10.1016/j.xnsj.2026.100855","url":null,"abstract":"<div><h3>Background</h3><div>Endoscopic lumbar fusion has emerged as a minimally invasive alternative to traditional open fusion, yet large-scale comparative evidence on postoperative safety and long-term effectiveness remains limited. This study evaluated national real-world outcomes following endoscopic versus open lumbar fusion.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was performed using the TriNetX US Collaborative Network. Adult patients undergoing endoscopic and open lumbar fusion were identified using ICD-10-PCS codes. Propensity score matching (1:1) generated 2 balanced cohorts (n=23,723 each). Ninety-day medical and surgical complications were compared using odds ratios (ORs) with 95% confidence intervals (CIs). One-year and 2-year pseudoarthrosis, instrumentation failure, and revision surgery were evaluated using risk ratios (RRs) with 95% CIs. Statistical significance was set at p&lt;.05.</div></div><div><h3>Results</h3><div>Endoscopic fusion demonstrated higher 90-day rates of UTI (OR: 1.20, 95% CI, 1.06–1.35, p=.003) and pneumonia (OR: 1.22, 95% CI, 1.01–1.47, p=.043). Among surgical outcomes, endoscopic fusion had higher post-operative hematoma (OR: 1.42, 95% CI, 1.05–1.92, p=.023) and SSI (OR: 1.36, 95% CI, 1.20–1.54, p&lt;.001), but lower wound complications (OR: 0.94, 95% CI, 0.79–1.11, p=.461) and CSF leak (OR: 0.59, 95% CI, 0.45–0.78, p&lt;.001). At one year, endoscopic fusion showed higher pseudoarthrosis (13.5% vs. 6.4%, RR: 2.10, 95% CI, 1.99–2.22, p&lt;.001), whereas rates of revision surgery were not significantly different (0.70% vs. 0.62%, RR: 1.14, 95% CI, 0.92–1.40, p=.231). Instrumentation failure remained lower (0.09% vs. 0.30%, RR: 0.31, 95% CI, 0.19–0.49, p&lt;.001). At 2 years, pseudoarthrosis (18.9% vs. 8.8%, p&lt;.001) remained higher, instrumentation failure remained lower (0.2% vs. 0.65%, p&lt;.001), and revision surgery occurred at similar rates (1.60% vs. 1.60%, p=.994).</div></div><div><h3>Conclusions</h3><div>Endoscopic lumbar fusion was associated with higher rates of several medical and infection-related complications, as well as significantly higher pseudoarthrosis at 1 and 2 years, while demonstrating lower instrumentation failure. These findings highlight distinct risk profiles between techniques and emphasize the importance of patient selection and continued refinement of endoscopic fusion approaches.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100855"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}